Not Dead Yet: The Right Plays Chicken with Women’s Lives

Not Dead Yet: The Right Plays Chicken with Women’s Lives March 12, 2019

A Rewire investigation into public hospitals denying women abortions is frankly horrifying.

Have a look:

When she arrived at the public hospital in Texas, the woman was so sick she couldn’t walk. About four months pregnant, she needed an abortion to save her life. A previous pregnancy had led to heart failure. This time she faced a higher risk of death from cardiac arrest that increased as the pregnancy advanced.

But the hospital’s leadership denied her the abortion she needed.

“It was decided that she was not going to be dying at that moment,” Dr. Ghazaleh Moayedi, who cared for the patient, told Rewire.News. “It really was almost a cruel joke: that she wasn’t really dead enough to warrant intervention.”

A case like this should be a no-brainer. She almost died during a previous pregnancy. She’s got the same symptoms this time, and she’s already so sick she can’t walk. At four months, she’s still before the point of fetal viability. It’s open and shut. And apparently not. 

Why was she denied an abortion? This is why:

In Texas, a 2011 law effectively bans abortion in “hospital districts”: publicly funded entities that provide subsidized care to the poor. The only exceptions, at least for now, are cases where the fetus can’t survive outside the womb or the patient’s condition “necessitates the immediate abortion of her pregnancy to avert her death or to avoid a serious risk of substantial impairment of a major bodily function.” (A Texas lawmaker just introduced legislation to repeal the first exception.) Access to abortion is so limited in Texas that it’s difficult to pin denials of care like the one Moayedi described on any single measure. Some hospital districts refused to provide abortions except in cases of life endangerment even before legislators enshrined these restrictions in law.

While the averting death exception ought to have been enough for Dr. Moayedi’s patient, the hospital’s leadership team disagreed. They ruled that she wasn’t close enough to death for it to count. She wasn’t dying yet.

When Moayedi broke the news, the patient was devastated. She was too ill to be seen in an outpatient clinic that lacked advanced resuscitation and heart monitoring equipment. Her options were to travel to New Mexico and pay thousands of dollars for a hospital abortion there—which she couldn’t afford—or continue a pregnancy that might kill her. Like millions of people in Texas, she lacked health insurance.

Moayedi doesn’t know what happened to the patient. She never saw her again.

This is absurd.

It also doesn’t appear to be a limited problem.

After she moved to another part of Texas, Moayedi appealed to a different public hospital for a patient with a pregnancy condition that put her at risk for complications including hysterectomy and hemorrhaging. The case seemed urgent to Moayedi, who had already watched one patient who carried a pregnancy to term with this condition require a 13-unit blood transfusion—more blood than a human body typically contains.

Again, hospital leadership said no to the abortion.

“The response was that it was not actually imminently life-threatening, that sometimes people lived from the condition and so they would not intervene,” Moayedi said.

This time, Moayedi was able to refer the woman to a private hospital.

What’s going on with these hospital leadership boards? Are they ideologues themselves, or are they afraid of facing sanctions under the Texas law if they grant exceptions like these?

The way the law is being interpreted, the exception is only available for women in emergency situations who are literally bleeding out. Women whose pregnancies are high risk and carry a significant chance of death or serious complication, or side effects that may be be irreversible? They’re not literally dying right now, so it doesn’t count.

A lot of things can be obscured by terminology. We can all say the same words—“life of the woman”—and yet mean completely different things. I would assume, for example, that a woman with cancer who needs chemotherapy should be able to obtain an abortion under the “life of the mother” exemption, but I would be wrong—if she’s not dying right then it doesn’t count. At least, not for public hospitals in the states profiled in Rewire.

Here’s something I was not aware of: the refusal of public hospitals (and other hospitals) to provide abortion services for women with high risk pregnancies has led to freestanding clinics offering high-risk abortions that ought to be performed in a hospital setting, because no hospital will accommodate these women’s needs and these women’s lives are at stake. 

When such patients can’t find a willing hospital where they can afford care, it puts outpatient abortion providers in an unsettling bind. Doctors in multiple states told Rewire.News they sometimes perform abortions in clinics that should ideally be done in a hospital, because the alternative is to force patients to continue a potentially fatal pregnancy. Freestanding clinics generally lack the equipment to perform emergency hysterectomies or blood transfusions.

Yes, you read that right—some abortion providers are performing risky abortions that ought to be performed in a hospital in free standing clinics instead, because no hospital will take the woman and the pregnancy is life threatening. Better a risky abortion in a facility not designed for it than for the woman to die from a high-risk pregnancy, when those are your options.

Dr. Bhavik Kumar, an abortion provider at a stand-alone facility in Texas, said he recently safely performed an abortion for a patient whose placenta was in danger of growing into her cesarean-section scar. Another doctor had recommended the woman have her abortion in a hospital, but she said two hospitals—one that was part of a public hospital district, the other a faith-based nonprofit—refused to do the procedure. In New York, where he trained, Kumar said he “absolutely” would have referred this patient to a hospital. In Texas, he had no other option.

“For this patient, the safest thing is for her to be not pregnant as soon as possible,” Kumar said.

You know how abortion opponents have been pushing for laws requiring abortion doctors to have admitting privileges at nearby hospitals, under the argument that this makes things safer for women? Are these same lawmakers willing to get behind laws requiring hospitals to provide abortion services, because when there are complications that is after for women? 

My guess is no. 

Zeal faced this same bind when she worked at an abortion clinic in neighboring Oklahoma, which has similar restrictions on insurance and public facilities and where—as in several states with similar laws—more than a quarter of hospital beds are in Catholic facilities that oppose abortion on religious grounds.

“There were definitely patients that were referred [to the clinic] for abortion services for a life-endangering pregnancy for medical co-morbidities that in other places would definitely warrant an in-hospital procedure,” Zeal said. “But that just was not an option for them, because there was no way they could access a hospital that would provide the service.”

Read the whole Rewire article. It’s like this all the way through. It’s utterly and completely horrifying.

The patients most affected by these laws are those too sick to be seen in outpatient clinics, but not sick enough for their hospital to allow an abortion.

You’re reading that right—some women get stuck in a middle with no answer, hospitalized due to their pregnancy and at once too sick to go to a freestanding abortion clinic and not close enough to death to receive an abortion in their hospital. Typically, the solution is to look for another hospital that will take them and provide the abortion, but this can be challenging.

Chrisse France, executive director of the Cleveland abortion clinic Preterm, said it’s not unusual for providers there to deem someone too sick for outpatient care. That patient may have nowhere else to go. Private hospitals may refuse to accept her if she is uninsured or using Medicaid, which in Ohio and most other states covers abortion only for rape, incest, or life endangerment. And the public hospital, typically a safety net for poor patients, is out of the question.

“She cannot be seen at our public hospital unless pretty much she’s going to die today or maybe tomorrow,” France said. “For example, if she has cancer and needs chemo—and going without chemo is obviously bad for her health—and she wants an abortion, they can’t do it unless she’s literally ready to die.”

In the states profiled in the Rewire article, abortion is not permitted in public hospitals unless a woman’s life is in immanent danger (i.e., she is literally dying). Catholic hospitals are also off limits; these facilities tend to refuse to perform abortions unless fetal demise has already occurred (this is how Savita Halappanavar died). But the problem does not end there.

As the article notes, private hospitals may refuse to accept a patient if she is uninsured, or if she is on Medicaid, which only covers abortion if—you guessed it—a woman is literally dying (Medicaid also covers cases of rape and incest, but proving this exemption can be tricky, and even when can be obtained, the exemption is limited to women pregnant by rape or incest.)

This is the country we live in.

In Ohio, as in most of the 11 states with laws targeting public facilities, there is no exception for fetal anomalies. In December 2018, Chelsea, who asked Rewire.News not to use her last name, was about 15 weeks into a planned pregnancy when a specialist at University of Cincinnati Medical Center told her that her fetus had triploidy, a condition where three sets of chromosomes develop in each cell instead of two. Babies with triploidy are stillborn or die shortly after birth.

The news devastated Chelsea, who had suffered a miscarriage months earlier. The condition also put her at higher risk for choriocarcinoma, a fast-growing cancer, and preeclampsia, a potentially deadly pregnancy complication characterized by high blood pressure. Chelsea’s blood pressure had already been unusually high. Then the doctor delivered the final blow: Affiliated with a public university, the hospital would end her pregnancy only once Chelsea was too sick to continue it.

“My head was spinning because of the information that I was being given, but I just felt like I was on an alien planet,” Chelsea told Rewire.News. “There was no question in my mind: I’m not going to risk my organ function to carry a non-viable pregnancy to term.”

It didn’t end there, for Chelsea.

In greater Cincinnati, the last private hospital to perform abortions for fetal anomalies reportedly stopped doing so in late 2015. Deepening Chelsea’s stress was the fact that Ohio was on the verge of eliminating the procedure she needed; the week of her diagnosis, state lawmakers approved a ban on the most common and safe method of second-trimester abortion, with no exception for fetal anomalies.

Ultimately, Chelsea obtained an abortion at Planned Parenthood, but to do so she had to visit three separate times and read pamphlets about parenting and adoption, deepening her pain. Remember, this was a wanted pregnancy. Chelsea was also unable to have general anesthesia in the clinic, which meant she had to be awake for the procedure—something she didn’t want.

Oh, and the problems don’t end here, either.

Indeed, Catholic hospitals, which make up one in six acute-care beds nationwide, have sent miscarrying patients home while bleeding and in pain under religious directives that ban most abortions. A doctor at a Catholic hospital in Wisconsin told Rewire.News she had to wait overnight for a patient’s temperature to soar—a sign of infection—before she could end the pregnancy the woman was losing at 18 weeks.

At some hospitals subject to the public facilities laws, there’s a similar policy. A doctor in the Midwest, who requested anonymity, said that her institution waits for patients to run a fever if their water breaks long before fetal viability—a scenario where infection is all but inevitable.

We’re talking about miscarriages—when a woman’s water breaks before fetal viability, her fetus cannot survive. There’s a reason hospitals induce women at term if their water breaks and labor does not begin within 24 hours—the risk of infection is high. If a woman’s water breaks before viability and she does not miscarry, she needs an abortion.

According to the Rewire article, some Catholic hospitals and public hospitals have an actual policy of waiting for a woman in such a situation to run a fever, indicating that infection is setting in. Then they can justify performing an abortion.

Is it any surprise our maternal mortality rate looks like this?

What’s a woman’s life worth? I’m reminded of Chelsea’s statement: “I’m not going to risk my organ function to carry a non-viable pregnancy to term.” Perhaps the question is not so much what is a woman’s life worth as it is what is a woman’s body worth. Or maybe, what is a woman’s health worth. Chelsea was told that she could be given an abortion the moment she was “too sick” to continue her pregnancy—hence the organ function comment. Chelsea’s life would be saved—but her health? Not so much. That politicians are willing to gamble with.

I can’t help but feel that this wouldn’t be happening if men could get pregnant too. Would men be expected to risk organ function to carry a nonviable pregnancy—or any pregnancy? Somehow I doubt it. 

As supportive as I am of universal healthcare, stories like Rewire’s have me worried. If we had universal healthcare—a system like those in most other western countries, where doctor’s visits and medical procedures are covered at now cost, funded by tax dollars—what would women’s access to abortion look like? Conservatives have already attempted to ban health clinics that provide abortion services from receiving public Medicaid funding for other services they offer—imagine how much worse this could be if all medical funding was public.

Women’s health ought to be a place everyone can come together. We’re not talking about your average run-of-the-mill elective abortion. Conservatives believe that the fetus is a person with rights; we’re talking about cases where there’s a second life at stake—the woman’s. In a contest between the two, surely women should be allowed to choose their own.

But then, that may be why we’re where we are—if a woman is literally dying, according to these laws and policies, she can have an abortion. But if she only might die—or if she might be physically impaired—that is a risk she ought to be willing to run, for the sake of the other life.

But you know what? That ought to be the woman’s decision. We don’t legally sanction people who don’t run into burning buildings to save children. We shouldn’t legally sanction women who aren’t willing to risk their health to continue a pregnancy.

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